• Davide Seripa, Madia Lozupone, Giuseppe Miscio, Eleonora Stella, Maddalena La Montagna, Carolina Gravina, Maria Urbano, Lazzaro di Mauro, Antonio Daniele, Antonio Greco, Giancarlo Logroscino, Francesco Panza, and Antonello Bellomo.
• Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari Laboratory of Clinical Chemistry, Department of Clinical Pathology, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia Institute of Neurology, Catholic University of Sacred Heart, Rome Department of Clinical Research in Neurology, Neurodegenerative Disease Unit, University of Bari "Aldo Moro", Azienda Ospedaliera "Card. G. Panico", Tricase, Lecce, Italy.
• Medicine (Baltimore). 2018 Sep 1; 97 (37): e11998e11998.

RationaleIn psychiatric disorders, interindividual differences in cytochrome P450 (CYP)2D6 (CYP2D6) enzymatic activity could be responsible of adverse drug reactions (ADRs) and therapeutic failures (TFs) for CYP2D6-metabolized drugs, contributing to the periodical hospital readmissions of the revolving door (RD) condition.Patient ConcernsWe investigated CYP2D6 genotypes in a controlled series of 5 consecutive RD patients with Bipolar Disorder (BD).DiagnosesPsychiatric patients affected by Bipolar Disorder.InterventionsWe defined TFs as a difference at the Brief Psychiatric Rating Scale score ΔBPRS < 25% at each 1-week of stable treatment, and ADRs as the onset of extrapyramidal symptoms and/or metabolic impairment with weight gain.OutcomesAt 3 months, a mean number of 2.75 ± 1.26 ADR and a mean ΔBPRS score of 16.07 ± 0.05% were observed. At 6 months of follow-up, compared to the only patient without BD (ΔBPRS < 32.10%), BD patients (n = 4) showed TFs (ΔBPRS < 25%). CYP2D6 genotyping revealed intermediate metabolizer phenotypes for BD patients and an extensive metabolizer phenotype for the patient without BD. In BD patients, the ratio of drugs maintained/discontinued for TFs or ADRs was 1.75 for non-CYP2D6 versus 0.33 for CYP2D6 interacting drugs, while the proportion of ADR:TF was 0:4 versus 6:3.LessonsOur findings may suggest that CYP2D6 clinically relevant genotypes may be involved in the unwanted outcomes observed in RD patients with BD.

21 keywords...

hide…